Pathogen sequencing information of a Difficult Pulmonary Tuberculosis patient

This project presents a case report on the successful diagnosis of a difficult-to-detect case of pulmonary tuberculosis using hybrid capture-based targeted Next-generation sequencing (hc-tNGS). The patient, a 29-year-old male, presented with fever and cough lasting for more than 20 days, and multiple chest CT scans showed progressive enlargement of the right hilar lymph nodes and thickening of the interlobular septa in the right upper lobe. Despite multiple diagnostic tests, including bronchoalveolar lavage fluid analysis, tuberculosis bacilli search, bacterial and fungal cultures, X-pert MTB/RIF, and multiplex PCR-based targeted Next-generation sequencing (mp-tNGS), the diagnosis remained inconclusive. However, hc-tNGS testing of the bronchoalveolar lavage fluid, combined with special staining of the enlarged lymph nodes, ultimately confirmed the diagnosis of pulmonary tuberculosis. This case report highlights the significant value of hc-tNGS in diagnosing pulmonary tuberculosis, especially in cases that are difficult to detect with other methods, and suggests its potential as a routine diagnostic tool for enhancing the accuracy of early diagnosis in the future.